Download PDF
Am J Perinatol
DOI: 10.1055/a-2708-4947
Original Article

Characteristics and Categories of Fetal Heart Rate Tracings and Adverse Neonatal Outcomes at Term

Authors

  • Rachel Wiley 

    1   Department of Obstetrics, Gynecology and Reproductive Science, University of California San Diego, La Jolla, United States (Ringgold ID: RIN8784)

  • Aaron W Roberts

    2   Obstetrics, Gynecology and Reproductive Science, University of Texas McGovern Medical School, Houston, United States (Ringgold ID: RIN12339)

  • Kristen A Cagino

    3   Department of Obstetrics, Gynecology, and Reproductive Services, University of Texas McGovern Medical School, Houston, United States (Ringgold ID: RIN12339)

  • Fabrizio Zullo 

    4   University of Rome La Sapienza, Rome, Italy (Ringgold ID: RIN9311)

  • Hector Mendez-Figueroa

    5   Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas McGovern Medical School, Houston, United States (Ringgold ID: RIN12339)

  • Suneet P Chauhan

    6   Maternal-Fetal Medicine, ChristianaCare, Wilmington, United States (Ringgold ID: RIN5973)
Further Information
Also available at
 PDF Download
Preview

Objective: To compare characteristics and categories of fetal heart rate tracings (FHRT) among term (> 37.0 weeks) singletons without versus with composite adverse neonatal outcomes (CANO). Methods: For 15 consecutive months, FHRT of all deliveries were characterized by obstetricians, who were blinded to maternal characteristics, intrapartum course, and neonatal outcomes. The inclusion criteria were non-anomalous singletons at term, who labored and had at least 20 minutes of FHRT. CANO included any of the following: Apgar score < 7 at 5 minutes, mechanical ventilation for > 6 hours, hypoxic ischemic encephalopathy, seizure, sepsis, bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing, enterocolitis, birth injury, meconium aspiration syndrome, or neonatal death. Positive likelihood ratios (PLR), with pre- and post-test probabilities were calculated. Results: Of the 5,160 deliveries during the study period, 3,166 (61.4%) met inclusion criteria and 2,765 (87.3%) had between 20 and 120 min of FHRT reviewed. CANO occurred in 49 (1.5%) of the newborns. Three FHRT characteristics differed significantly among those without and with CANO—severe decelerations, tachycardia with any decelerations, or with severe decelerations. The PLR ranged from 1.60 to 5.96 for CANO, with post-test probabilities of CANO from 2.4% to 8.3%. Persistent category I within 20 to 120 min of delivery occurred with similar frequency among those without versus with CANO (11.5% versus 8.2%; P=0.472; PLR 0.71). Presence of category II anytime occurred similarly for those without and with CANO (88.5% versus 89.8%; P=0.785; PRL 1.01); category III, at any time, also occurred similarly in the two groups (0.8% versus 2.0%; P=0.319; PLR 2.65). Conclusion: In our cohorts of term singletons, neither the characteristics nor the category of fetal heart rate tracing provided clinically meaningful discriminative capacity between newborns with versus without composite adverse neonatal outcomes



Publication History

Received: 12 August 2025

Accepted after revision: 23 September 2025

Accepted Manuscript online:
24 September 2025

© . Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor , NY 10001 New York, USA